Organization
HAZELTON DIALYSIS LLC
Active
Other names
Bastanchury Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T. WEY (VP, LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
1950 SUNNYCREST DR, STE 1300, FULLERTON, CA 92835-3639
(714) 578-0015
(714) 578-5907
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1154755163
—
CA
Enumeration date
08/27/2013
Last updated
01/10/2025
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